Provider Demographics
NPI:1720185291
Name:LE, ANTHONY WATANA (DPM)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:WATANA
Last Name:LE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:945 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6756
Mailing Address - Country:US
Mailing Address - Phone:805-483-7799
Mailing Address - Fax:805-487-4841
Practice Address - Street 1:18370 BURBANK BLVD STE 107
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2813
Practice Address - Country:US
Practice Address - Phone:818-345-3338
Practice Address - Fax:818-345-3363
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4333213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89504Medicare UPIN